HomeMy WebLinkAbout0158343-Plumbing � CITY OF OSHKOSH °
� No 158343
OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN RETIREMENT COMM INC Create Date 10/09/2013
Contractor HURCKMAN MECHANICAL INDUSTRIES, INC. __ Category 442-Commercial-Interior(New/Relocated Fixt� Plan state review
Inspector Jerry Fabisch
Bathtub 0 Clothes Wshr 0 Classrm Sink 0 Surgeons Sink 0 Roof Drain 0 Deduct Meters 0
Shower 1 Lndry Tray _ 0 Exam Sink 0 Sterilizer _ 0 Soda Disp 0 Wtr Sewer Mtrs 0
Whirlpool _ 0 Sump Pump 0 F Prep Sink 0 RPZ Valve 0 Coffee Maker 0 Wtr Usage Mtrs 0
Lavatory 24 San Sump/Pump 0 FIr/Wst Sink 0 Bidet 0 Site Drain 0 Misc. p
Toilet 23 Water Softner 0 Hand Sink 0 Urinal 0 Wait.St. � Fixtures
Kit Sink 3 Standp Rec 0 Lab Sink 0 Beer Tap 0 Ice Chest p
Disposal _ 1 Gar Drain 0 Plaster Sink 0 Dip Well 0 Comm Ice Maker 0
Dishwasher 0 Local Waste _ 0 Sculry Sink _ 0 Drink Ftn 0 Int Grease Trap 0
Floor Drain _ 0 Bar Sink 0 Serv Sink 1 Wash Ftn 0 Ext Grease Trap 0
Hose Bibb 0 Breakrm Sink 0 Shamp Sink 0 Catch Basin 0 Eye Wash Statn 0
Water Heater 0
Use/Nature OMM\PHASE II MANOR VIEW 21 BED CBRF/Interior plumbing associated with the remodel of elderly living units
of Work er state approved plans"*check#39283
I
�'I :
,� :
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Parcelid#
1615311000
Valuation $97,200.00 Plan Approval $0.00 Permit Fees $477.00 ❑ Permit Voided I
Issued By Date 10/18/2013
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement,the City strongly urges the permit applicant to contact the
easement holder(s)and to secure any necessary approvals before starting such activity.
Signature Date
AgenUOwner
Address P O BOX 10977 GREEN BAY WI 54307 -0977 Telephone Number 920-499-6984 EXT 1
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number,Type of
Inspection (i.e. Footing,Service, Final, etc.),Access into Building if Secure(how do we gain entry),your Name and Phone
Number. Unless specified otherwise,we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
�
City of Oshkosh
Inspection Services Division �
P O Box 1134 �
Oshkosh,WI 54903-1130
Phone:(920)236-5050
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Ok THF WATFR �.
Plumbing Permit Application
I hereb3'�PP�Y�or a pe��E to da a�d�ss�l t�e fo�tu���eub�ng on the prec�is�s�ei�a.ftec deseribed,t�e wc�cle Ea ea�s€so�tcr�e
Wisconsin State Plumbing Code,in the performance of which all patties hereto agree to and are bound by said statutes.
* Application(s)and fee(s)can be brought to City Hall,R�m 205 or maiied#o inspectioz�Services,�'p Box 1 i28,C)sfikosh Wt
54903-1128. Commencing work without permit(s)will result in fees being doubled or$100.00 plus the normal permit fee,which
ever is greater.
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If vou are a contractor narticinating in the Permit Fee Account Svstem and have adeauate funds check here
i�vou wunllhis prvicessed ihrou�h your account n
**Advisory-For applicable projecCs,an Electrical Installation YeriHcation(EI�form,signed by the Electinical
Contractor or Hon�eownet(for installations allowed t�be perfot�ed by d�e homeowner)must be submitted
�vi�th t�e�it��tiicatie�n. A�c►ns s�hm�tte�arit�r�i�n F.�Y vr�c s�h is regaired,�rill nut 1�
prncessed fnr Pemiit Issnance and w�l be rCbnnned for completion.
�tt�M�
Job Address_��3o N,westfip�d Value��i�,a��r�a�a�s> $97,200 Date 1 QN 0/13
Owncr Evergr+een I2etirem�nt Community �ea��aete� Ht���kct�Mechanieal lnd�astt�es [ns
[�Single Family []Dnplea �Multi-Family �Rental
�Commercial �Industrial
Number of Fixtures:
Bamtub SwnP�P Plaster Sink Roof Drain
Shower �_ San.Sump/Pump Scullery Sink Soda Di
SP
�'��� ��a�c S�n�,� S�rviee Sink � Co€F�MMI�r�
Lavatory 24 Standpipe Rec Shamp Siak Site Drain
Toilet 23 Garage Fp Surgeons Sink Waitrs Sm
iCit Sink �_ Loc�i Wasnc St�criiizcr icc Chcst
Disposal 1 Baz Sink RPZ Valve Comm Ice Maker
���,q� Breakrtn Sink Bidet int Grease Ttap
Ileprlknin Gi�srn�S�c Uri�u3t Ea:t Grease Trap
Hose Bibb E�S� Bcer Tap Eye Wash Stn
Waaer Heaber F�eP S� Di{�er Well Deduct Meter
!!Cm4'+F,iect�±PwrVnt Floor Sink Drink Fnfi Wtr SewEr Mtr
Clothes Wshr Hand Sink Wash Fnfi Wtr Usage Mtr
Lndty Tray ��
Catct�Sasii� ������
Electric Contractor(for projects not requiring au EIV Form)
Use/Nai�re af Work_Phxnbing Remodel � 7'/ 'D�
Size Material Type # Conn.Type
�� 12ECEI'V D
Storm Sewer
�`'���"� OCT 152 13
� DEPART�1E17'OF
\_ r � �/ C0�4�tU\iTY DEVELOP�IEVT
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